Left main coronary artery compression syndrome in patient with pulmonary arterial hypertension. First clinical experience

Chest pain remains a common complaint in patients with pulmonary arterial hypertension (PAH). Compression of the coronary arteries is rare and probably underestimated syndrome being a typical cause of angina pectoris in patients with severe pulmonary arterial hypertension. Compression of the left main coronary artery (LMCA) by an enlarged pulmonary trunk is oftentimes associated with angina pectoris, but appropriate approaches to diagnosis and treatment remain poorly defined. This is a clinical case of a 38 years-old woman with idiopathic pulmonary arterial hypertension (IPAH) who has suffered from myocardial ischemia due to compression of the LMCA by a pulmonary artery aneurysm. The diagnosis of LMCA compression was made by coronary angiography (CA) and multispiral computed tomography (MSCT), which confirmed the pulmonary artery aneurysm as a source of external compression. LMCA stenting and changing in the PAH-specific therapy led to a significant improvement in angina, heart function and quality of life. Percutaneous coronary intervention appears to be feasible, safe and effective treatment for patients with external compression of the left coronary artery from pulmonary artery enlargement.